WHAT TO EXPECT: RADIATION ONCOLOGY. Your Care. Our Commitment.

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1 WHAT TO EXPECT: RADIATION ONCOLOGY Your Care. Our Commitment.

2 CHECKLIST OF IMPORTANT INFORMATION FOR YOUR FIRST VISIT Arrive 15 minutes early unless otherwise directed. Bring a list of all your current medicines. Please bring any outside records related to the reason for your visit. Make sure you have all necessary insurance and identification documentation. Plan on being in the department for approximately hours. Ask about parking options. YOUR CONSULTATION WITH THE RADIATION ONCOLOGIST Check in at the front desk and have a seat. When called, you will be escorted to an exam/ consultation room. A nurse or medical assistant will take your vital signs, review your medical history, and complete a patient assessment during this time. The nurse will discuss your case with the radiation oncologist (the doctor who will oversee your care while you are having radiation therapy). After reviewing your case with the nurse, the radiation oncologist will look at your recent tests, such as scans and labs, then will meet with you to discuss what role radiation oncology could play in your care. If you decide that radiation therapy will be part of your care plan, you will be scheduled for a simulation/planning appointment. UPMC is a teaching institution. At some of our Cancer Centers you may also meet with a resident during your consultation. THE DAY OF YOUR SIMULATION/ PLANNING SESSION On the day of your simulation/planning session, arrive 15 minutes early unless otherwise directed, and plan on being in the department for approximately 1 to hours. Wear comfortable clothes that are easy to remove. The treatment area on your skin may be marked with permanent marker, so be sure to wear something that is dark in color or is an old item, as the marker may rub off on your clothes. Check in at the front desk. When called, a radiation therapist will escort you to the simulation room. Your identification will be confirmed and a photo will be taken for your electronic record. During this time, you will be situated on a table in the treatment position that you will be in every day you have radiation therapy. Let the therapists know if you are claustrophobic, and they can help you to feel comfortable. Sometimes devices such as masks or body molds may be made to help you stay in the same position each day. You may be given tattoos at this time to serve as a map to help re-create the same positioning for treatment. More frequently, they are done within the first week of treatment. These permanent marks are generally the size of a freckle. During the simulation/planning appointment, we will take photos of you in the position that we have chosen for treatment. This is to make sure we have you in the same position every treatment day. When finished with the simulation, you will be given instructions on how to care for the marks placed on your skin. At the end of the appointment, you will be given an estimate of when you may be called back for a treatment set-up verification day. Sometimes, the planning process (after your simulation until the treatment set-up verification day) could take up to weeks. TREATMENT PLANNING/VALIDATION (BETWEEN YOUR APPOINTMENTS) All of the information acquired at your simulation/planning session will be sent to the dosimetrist or planner for review. The dosimetrist will work along with your radiation oncologist to formulate the best plan of treatment just for you. This plan is then entered into your electronic chart so that it can be accessed daily by the radiation therapists. After the plan is created and approved by your radiation oncologist, it will be checked by a physicist. During this process, the physicist thoroughly evaluates the plan created and often tests this plan on the treatment machine. When finished with the validation process, we will call you to schedule your treatment set-up verification day and daily treatment appointments.

3 THE TREATMENT SET-UP VERIFICATION DAY On treatment set-up verification day, arrive 15 minutes early unless otherwise directed. Wear comfortable clothes that are easy to remove, and plan on being in the department for up to 1 hour. Check in at the front desk and have a seat. When called, you will be escorted to the changing area or treatment room. Upon entering the treatment room, your identity will be confirmed by the radiation therapists. You will be asked to state two identifiers (typically name and birth date) to match this identification with our electronic system. This process will continue throughout the entirety of your treatment. The therapists will explain the procedure and answer any questions that you may have. We want to make sure you re involved with your care and are as comfortable as possible. You will be placed on a table similar to the one used during your simulation/planning session. The radiation therapists will move you into the treatment position determined when your simulation took place by using electronic controls and by physically moving your body. During this time, your job is to breathe normally while holding as still as possible. When you are in position, the machine will be placed to take x-ray images to confirm your positioning. The machine may come close to you, but it will not touch you. At this point, the radiation therapists will leave the room to take these images. The machine may make a slight buzzing noise when it s on. There are multiple cameras that can see you at all times and an intercom speaker is in the room so that the therapists can hear you and communication with you if needed. These images are then compared to the images created during your simulation/ planning session to make sure your treatment will be accurate. After confirming the treatment position, the radiation therapist may give you tattoos if you haven t received them already. These permanent marks are generally the size of a freckle. Simulation Image Treatment Set-up Image You will then be escorted out of the room by the radiation therapist. Most often you will begin your treatment the following day, however, in some instances you may start treatment on this day. DAILY TREATMENT Arrive 15 minutes early for your daily treatment unless otherwise directed. Wear comfortable clothes that are easy to remove, and plan on being in the department for 0-5 minutes. Check in at the front desk and have a seat. When called, you will be escorted to the changing area or treatment room. Upon entering the treatment room, your identity will be confirmed by the radiation therapists. The remainder of the treatment will be very similar to your first day. X-rays may not be taken daily but will be done at least once per week. This will generally only take a few extra minutes. The treatment itself is very similar to the x-rays. We ask that you breathe normally but hold very still. The machine makes a slight buzzing noise when it is on, but you will not feel anything. You may leave as soon as you are finished with your treatment. Any side effects discussed with you at the time of consultation will not occur immediately. During your first week of treatment, your radiation oncologist will review side-effect management with you. You will meet with your radiation oncologist once each week to discuss your progress. If you feel you need to speak with someone in addition to this, please inform your therapists and they will coordinate this with the nurse. We always have a radiation oncologist or nurse available if you wish to see someone on a day other than your weekly visit. Always ask the therapists, nurses, or doctors any questions that you may have throughout the course of your treatment. FOLLOW-UP On the last day of your treatment, we will give you an appointment for follow-up. Your radiation oncologist, your medical oncologist, or your referring physician will all communicate to coordinate your follow-up care. If at any time you need to contact us, please feel free to give us a call. If it is determined that you need to be seen, we will schedule you for an appointment. In the event of an emergency, please call 911 or go to the nearest emergency room. QUALITY AND SAFETY Treatment Set-Up Verification Day: This practice run is used for the first day you are on the treatment machine. During this time, you will be set up in the same position as you were on your simulation day and all parameters planned will be checked. Image Review: Every x-ray taken during your treatments will be reviewed by your radiation oncologist to make sure your treatment is exactly as planned. Chart Rounds: Your journey through treatment will be discussed by the whole radiation oncology team each week you are on treatment. Peer Review: In some cases, your plan may be reviewed by another radiation oncologist in our system. This educational process is important for continuous quality improvement in our organization. Weekly Physics Checks: Your treatment chart will be checked weekly by a physicist to ensure quality. MACHINE CHECKS The treatment machines are thoroughly checked daily before any treatments are given. A physicist monitors any checks performed and does an in-depth check on both a monthly and yearly basis. FOR ADDITIONAL INFORMATION For additional information, directions, and parking arrangements, please visit the UPMC CancerCenter website at 5

4 B NEW YORK IRELAND 1 Dublin Erie Waterford UNITED KINGDOM Warren NETHERLANDS BELGIUM GERMANY Pittsburgh Crawford L Forest 9I POLAND AUSTRIA NORWAY DENMARK SWEDEN ICELAND CZECH REPUBLIC Venango N FRANCE SWITZERLAND PORTUGAL ITALY CHINA Mercer 10J 1A Clarion PHILIPPINES UPMC SHADYSIDE CAMPUS Hillman Cancer Center Mary Hillman Jennings Radiation Oncology Center RADIATION ONCOLOGY CENTERS 1 Jameson Radiation Oncology 1 Heritage Valley Radiation Oncology, Beaver 1 Heritage Valley Radiation Oncology at UPMC West 1 UPMC/St. Clair Hospital Cancer Center 1 5 Jefferson Regional Radiation Oncology 1 6 Washington Health System Radiation Oncology 1 7 Uniontown Hospital Radiation Oncology, Robert E. Eberly Pavilion 1 8 UPMC CancerCenter Radiation Oncology at UPMC East 9 Butler Health System Radiation Oncology 1 10 UPMC CancerCenter Radiation Oncology at UPMC Altoona LOCATIONS MEDICAL ONCOLOGY CENTERS A UPMC CancerCenter Medical Oncology, New Castle B UPMC CancerCenter Medical Oncology, Beaver C Tony Teramana Medical Oncology D UPMC CancerCenter Medical Oncology, Sewickley E UPMC CancerCenter Medical Oncology, Upper St. Clair F UPMC CancerCenter Medical Oncology, Jefferson G UPMC CancerCenter Medical Oncology, Washington H Arnold Palmer Medical Oncology, Oakbrook Commons I Arnold Palmer Medical Oncology, Mt. Pleasant J UPMC CancerCenter Medical Oncology, Uniontown K UPMC CancerCenter Medical Oncology, Windber L UPMC CancerCenter Medical Oncology at UPMC Mercy M UPMC CancerCenter Medical Oncology, Indiana N UPMC CancerCenter Medical Oncology, Greenville O UPMC CancerCenter Medical Oncology, Monroeville P Butler Health System Medical Oncology 1 Q UPMC CancerCenter Medical Oncology at UPMC Passavant-Cranberry DUAL CENTERS (RADIATION AND MEDICAL ONCOLOGY) 1A UPMC CancerCenter at UPMC Horizon B The Regional Cancer Center, Erie C UPMC CancerCenter at UPMC Passavant D UPMC CancerCenter, Natrona Heights 5E UPMC CancerCenter at UPMC McKeesport 6F Arnold Palmer Cancer Center 7G John P. Murtha Regional Cancer Center 8H UPMC CancerCenter at UPMC St. Margaret 9I UPMC CancerCenter at Magee-Womens Hospital of UPMC 10J UPMC CancerCenter at UPMC Northwest INTERNATIONAL 1 UPMC Beacon Hospital, Dublin, Ireland UPMC Whitfield Cancer Centre, Waterford, Ireland UPMC San Pietro FBF Advanced Radiotherapy Center, Rome, Italy Partnership with the Asian American Medical Group (AAMG), Singapore 1 In partnership with UPMC CancerCenter A partnership of Trinity Health System and UPMC CancerCenter A partnership of Excela Health and UPMC CancerCenter A partnership of UPMC CancerCenter and Memorial Medical Center BHUTAN NEPAL BANGLADESH Rome SPAIN BURMA LAOS Jefferson Clearfield A 1 INDIA Lawrence 9 P Butler Beaver B Armstrong Q Indiana THAILAND M C D 8 O Cambria 8H 10 Blair 5E Westmoreland H 7G 6F Allegheny Pittsburgh CAMBODIA VIETNAM D E F 5 K SRI LANKA I G 6 Washington MALAYSIA Bedford Fayette Somerset MALAYSIA J 7 Singapore Greene INDONESIA MARYLAND WEST VIRGINIA INDONESIA WEST VIRGINIA OHIO 6 7 C

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